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General NPI Number Information
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NPI Number | 1639801541
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Entity Type | Individual
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Provider Name | ABRAHAM BAUTISTA MORA
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Gender | Male
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Dates
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Enumeration Date | 06/29/2022
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Last Update Date | 06/29/2022
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Provider Practice Location Address
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Address Line | 6214 RIVERDALE AVE # 1A
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City | BRONX
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State | NY
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Zip | 10471-1032
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Country | US
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Telephone | 718-701-4807
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Fax | 718-701-4806
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Provider Business Mailing Address
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Address Line | 1920 AMSTERDAM AVE APT 13L
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City | NEW YORK
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State | NY
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Zip | 10032-5024
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Country | US
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Telephone | 516-467-7821
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 109449
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License Number State | NY
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